Recommendations and rationale for the treatment of pelvic inflammatory disease

Abstract

Pelvic inflammatory disease (PID) is one of the most common serious infections of nonpregnant women of reproductive age. Management of PID is directed at containment of infection. Goals of therapy include the resolution of clinical symptoms and signs, the eradication of pathogens from the genital tract and the prevention of sequelae including infertility, ectopic pregnancy and chronic pelvic pain. The choice of an antibiotic regimen used to treat PID relies upon the appreciation of the polymicrobial etiology of this ascending infection including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and other lower genital tract endogenous anaerobic and facultative bacteria, many of which are associated with bacterial vaginosis. Currently available evidence and the CDC treatment recommendations support the use of broad-spectrum antibiotic regimens that adequately cover the above named microorganisms. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens consisting of an extended-spectrum cephalosporin in conjunction with either azithromycin or doxycycline. Clinically severe PID should prompt hospitalization and imaging to rule out a tubo–ovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly Gram-negative aerobes and anaerobes, should be implemented.

Keywords::

• antimicrobial treatment
• pelvic inflammatory disease
• PID
• tubo–ovarian abscess

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

writing assistance was utilized in the production of this manuscript.

Notes

Data taken from [50,51].

Data taken from [10].

Data from [52].

Data taken from [18].

Data taken from [18].

^†Intravenous antibiotics can be switched to oral antibiotics after 48–72 h of therapy or based on clinical judgment.

^‡If Chlamydia positive, add either azithromycin or doxycycline.

^§Culture for quinolone-resistant Neisseria gonorrhoeae is required if the quinolones are used.

^†A single dose may be substituted. Adapted from [49].